EHRs Underused For Hospital Infection Reporting

Half of infection prevention specialists are unaware if their organizations even participate in electronic health information exchanges, says study.

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Not only are electronic health records (EHRs) and health information exchange (HIE) underutilized by those on the front lines of preventing and reporting infections, many infection control professionals are unaware of their own employers' health IT capabilities, newly published research suggests.

In a survey conducted by informatics researchers at the Regenstrief Institute and the affiliated Indiana University-Purdue University Indianapolis, just one in 10 "infection preventionists," or IPs, said the organization they work for was "formally engaged" in health information exchange. In fact, 49% said they were unaware of whether their organization even participated in HIE.

One of the central functions of public-health agencies is to conduct surveillance of disease and infection outbreaks, including sexually transmitted diseases and cases of methicillin-resistant Staphylococcus aureus (MRSA). "Unfortunately, many notifiable diseases are reported less than half the time, and the time lag between diagnosis and submission for those reported to public health can be as high as three weeks," said the study, which appears in the American Journal of Infection Control.

According to the study, 71% of infection control specialists said they primarily reported relevant cases to health departments by printing and faxing information, and another 26% said they electronically fax at least a portion of reportable public health data. Only 8% said their hospitals use electronic laboratory reporting technology, and just one of the 38 people who answered the question said her organization reported data electronically via an HIE. "Although available to many [infection preventionists], EHR systems are providing little more than an electronic window into a patient's chart," the authors wrote.

"By simply replacing paper medical records with electronic folders, IPs will continue to spend significant portions of their time manually combing through laboratory, physician, and nursing reports to determine whether or not a notifiable disease is present and should be reported to public health," they added.

Lead author Brian E. Dixon, who conducted the survey as part of his Ph.D. dissertation, actually expected to hear that many infection control specialists were not sure whether their organizations even participated in an HIE. "To me, it's not surprising," Dixon said, "especially given the low percentage of infection prevention specialists who were involved in health IT design."

Some 72% of those surveyed said their organizations used an EHR, but only 18% said the infection control department had been invited to participate in design, selection or implementation of the EHR. "Based on our findings, there is a need for more IPs to be more aware of and engaged in EHR and HIE activities," the study said.

Dixon told InformationWeek Healthcare that other studies he has done showed that even many hospital executives were unsure if their organizations participated in HIEs. "It's not quite in the culture yet," Dixon said. "When organizations look at a new health IT system, their emphasis is on front-line care."

Pathologists are not typically on the front lines of care, and laboratories often have specialized information systems that might not be integrated with institutional EHRs. Plus, infection reporting still tends to be a manual process, Dixon said.

Citing 2010 data from the U.S. Centers for Disease Control and Prevention (CDC), the Regenstrief researchers said that no state health department receives 100% of notifiable lab reports electronically. However, they noted that Stage 2 of the Meaningful Use electronic health records (EHR) federal incentive program requires hospitals to send electronic lab reports to public health agencies.

HIE, another component of Meaningful Use, can help improve infection control, previously published research has shown. The Regenstrief researchers said they were unaware of any earlier studies looking at the attitudes of infection-prevention professionals about the potential of health IT to improve disease surveillance. "The adoption and use of EHR systems and HIE also provides an opportunity to address redundant and variable reporting mechanisms that make notifiable disease reporting inefficient," they wrote.

However, EHR user interfaces currently are set up for manual routing of pertinent information regarding infectious diseases, according to Dixon. "It doesn't show up in the workflow of an IP," he said.

Dixon said there are two keys to changing the prevailing culture. First, there needs to be greater awareness among infection-prevention professionals of the need to be involved in EHR planning and implementation. Second, vendors and system designers need to start supporting public health reporting.

As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)

I think this is more of a problem with not sufficiently training infection control specialists within organizations on the capabilities offered with the EHR systems and organization health IT system as a whole. These individuals need to get more involved in EHR planning and implementation in order to fully understand and use the systems. EHR systems have great reporting capabilities that can be used by the infection control specialists and under Stage 2 of Meaningful Use; they will have to be used to report to public health agencies. It would be better that they get involved sooner than later and get a feel for what the systems have to offer them.